HIV therapy after treatment interruption in patients with multiple failure and more than 200 CD4+ T lymphocyte count

✍ Scribed by Acil Jaafar; Patrice Massip; Karine Sandres-Sauné; Corinne Souyris; Christophe Pasquier; Christian Aquilina; Jacques Izopet

• Publisher: John Wiley and Sons
• Year: 2004
• Tongue: English
• Weight: 162 KB
• Volume: 74
• Category: Article
• ISSN: 0146-6615
• DOI: 10.1002/jmv.20139

✦ Synopsis

Abstract

The aim of the study was to investigate the safety and efficacy of a salvage therapy initiated after interrupting treatment in patients with virological failure and more than 200 CD4^+^ T lymphocyte count. In this prospective study, 77 patients who received failing regimens had stopped completely all medication for 3 months before starting an optimised regimen consisting of 3–5 drugs. Patients were tested for HIV resistance before and after treatment interruption. Discontinuation of therapy for 3 months was associated with a median increase in HIV RNA of 1.1 log~10~, a median decrease in CD4^+^ T cell count of 136 × 10^6^/L and five clinical events related to HIV, but no AIDS‐defining event. Eighty‐seven percent of patients showed a shift from a drug resistant genotype to a wild‐type genotype based on the major resistance mutations. Forty‐seven percent of patients with a genotype shift reached fewer than 200 HIV RNA copies/ml of plasma 6 and 12 months after treatment resumption whereas none of those without a genotype shift did so (P = 0.03). However, the genotypic shift was not associated with a sustained virological response by multivariate analysis. The use of a new therapeutic class of compound in the salvage regimen was the only predictor of the sustained virological response. Salvage therapy with 3–5 drugs after interrupting treatment for 3 months can be a safe and effective strategy provided the HIV disease is not too advanced. Randomised trials in this population are needed to assess the clinical benefit of this strategy. J. Med. Virol. 74:8–15, 2004. © 2004 Wiley‐Liss, Inc.